Critics claim that spine and joint surgeons are being swayed by device manufacturer “kickbacks” disguised as legal consulting fees and royalties and that this influence is harming patients, reports the Washington Examiner.

Medical device makers have paid $3.1 billion to orthopedic and neurosurgeons from 2013 to 2019, based on data from the federal government website OpenPayments, according to Kaiser Health News.

Under federal law, it is illegal for physicians to take anything of value from a medical device manufacturer in exchange for using its products. Yet, it is legal for physicians to receive speaking and consulting fees from such companies. They may also receive royalties in exchange for assisting in the design of medical devices.

Critics contend the in-practice kickbacks are often camouflaged as consulting and other fees. They claim this can lead to physicians using inferior products and conducting unnecessary surgeries that harm the patient.

Read more in the Washington Examiner.